妊娠期急性肾损伤的相关进展

Research Progress of Acute Kidney Injury in Pregnancy

妊娠期间肾脏损伤风险至少增加2倍,妊娠期急性肾损伤(acute kidney injury in pregnancy,P-AKI)是一种高风险产科疾病,严重威胁母亲和胎儿的健康。尽管P-AKI在过去30年中发病率下降,我国仍有较高的发病率及致死率。P-AKI是妊娠期严重的并发症,有起病急、进展快、病情重的临床特点,常伴有呼吸、心血管及消化等系统的症状。P-AKI的相关疾病,如子痫前期、妊娠期急性脂肪肝、HELLP综合征和血栓性微血管病等临床表现相似,容易出现诊断困难。现总结近年来国内外文献,从P-AKI病理生理变化、不同地区发病率及诱因、诊断标准、P-AKI的相关疾病及预防治疗措施等进行分析,并对P-AKI的透析指征进一步分析,旨在提高大家对疾病的了解、预防和诊治,降低发病率、病死率及致残率,改善母婴结局。

The risk of kidney damage doubles during pregnancy. Acute kidney injury in pregnancy (P-AKI) is a high risk obstetrical disease that threatens the lives of mothers and their children. Despite the decline in the incidence of P-AKI in the past three decades, China still has a high incidence and mortality rate. P-AKI is a serious complication of pregnancy. It has clinical features of rapid onset, rapid progress and serious illness, often accompanied by respiratory, cardiovascular and digestive symptoms. P-AKI related diseases such as pre-eclampsia, acute fatty liver in pregnancy, HELLP syndrome and thrombotic microangiopathy have similar clinical manifestations and are prone to diagnosis difficulties. This article analyzes the pathophysiological changes, the incidence and causes of different countries, the diagnostic criteria, the related diseases of P-AKI and the preventive and therapeutic measures, further analyzes the dialysis for P-AKI. It aims to improve the prevention and treatment of P-AKI, reduce the incidence, mortality and disability, and improve maternal and child outcomes.